Tratamiento de dolor agudo en niños

Tratamiento de dolor agudo en niños
Acute pain management in children.
Verghese ST, Hannallah RS.
The George Washington University Medical Center, Division of Anesthesiology, Children's National Medical Center, Washington, DC, USA.
J Pain Res. 2010 Jul 15;3:105-23.
Abstract
The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain is constantly being refined; with newer drugs being used alone or in combination with other drugs continues to be explored. Several advances in developmental neurobiology and pharmacology, knowledge of new analgesics and newer applications of old analgesics in the last two decades have helped the pediatric anesthesiologist in managing pain in children more efficiently. The latter include administering opioids via the skin and nasal mucosa and their addition into the neuraxial local anesthetics. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The development of receptor specific drugs that can produce pain relief without the untoward side effects of respiratory depression will hasten the recovery and discharge of children after surgery. This review focuses on the overview of acute pain management in children, with an emphasis on pharmacological and regional anesthesia in achieving this goal
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004641/pdf/jpr-3-105.pdf


Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Al revés: Flipped Classroom, un nuevo método de enseñanza para cambiar el modelo tradicional de clase

Aprendiendoaenseñar
Curated by Wilmer Ramírez

Maestr@s y redes de aprendizajes - September 21, 12:57 PM




Al revés: Flipped Classroom, un nuevo método de enseñanza para cambiar el modelo tradicional de clase 

Muchos educadores están experimentando con el modelo de “flipped classroom” o “clase del revés”. ¿Pero en qué consiste? Esta técnica invierte los modelos tradicionales de enseñanza, dando instrucciones online desde fuera de la clase y trasladando los deberes dentro de la clase. El método tradicional representa al profesor como la persona que imparte la clase y manda deberes para el día siguiente. En el nuevo modelo el profesor permanece a un lado ejerciendo como guía y mientras que los alumnos trabajan en la clase. El modelo requiere que los alumnos vean los videos online en casa, en su propio espacio, en constante comunicación con otros alumnos y profesores mediante debates online. Es en la clase en donde los conceptos se afianzan con la ayuda del profesor. La tecnología y las actividades de aprendizaje son dos componentes clave de este nuevo modelo. Ambos influencian el entorno de aprendizaje del estudiante de manera fundamental. ¿Cómo apareció? Muchos factores influenciaron la creación y adopción del modelo de la “clase al revés”
Sin embargo dos innovadores jugaron un papel fundamental, los profesores Jonathan Bergman y Aarom Sams del instituto Woodland Park en Colorado, EEUU. En el año 2007 descubrieron un software para grabar presentaciones en PowerPoint y publicaron las lecciones en internet para aquellos estudiantes que habían faltado a las clases. Las lecciones online se fueron ampliando y se propagaron rápidamente. Ambos profesores comenzaron a dar charlas a otros profesores sobre sus métodos de enseñanza así que el resto de profesores comenzaron a usar los videos online y video podcasts para enseñar a los alumnos fuera del aula, reservando el tiempo de clase para ejercicios en grupo y ejercicios de revisión de conceptos...

Books Update NYT

September 21, 2012
Books Update


On the Cover of Sunday's Book Review

'This Is How You Lose Her'
By JUNOT DIAZ
Reviewed by LEAH HAGER COHEN


Junot Díaz's new collection of stories features a familiar character, Yunior, and themes of family history, cultural mores and romantic infidelity.


Also in the Book Review

Emma Thompson: By the Book


The actress and author of a new children's book, "The Further Tale of Peter Rabbit," has contemplated throwing the writer Michel Houellebecq across a room.
By the Book: Archive

'Battleborn'
By CLAIRE VAYE WATKINS
Reviewed by ANTONYA NELSON


Claire Vaye Watkins's stories show a concern for knowing the past and surviving the present.
ArtsBeat Q. and A.: Claire Vaye Watkins

'From the Ruins of Empire'
By PANKAJ MISHRA
Reviewed by HARI KUNZRU


Pankaj Mishra's group portrait of the thinkers whose ideas shaped contemporary China, India and the Muslim world.

'NW'
By ZADIE SMITH
Reviewed by ANNE ENRIGHT


Zadie Smith's novel presents characters of varying (and sometimes mixed) races, ethnic groups and classes.

'All Gone'
By ALEX WITCHEL
Reviewed by MAGGIE SCARF


Alex Witchel describes how her vibrant mother's personality vanished despite her robust body.

'The Cocktail Waitress'
By JAMES M. CAIN
Reviewed by MICHAEL CONNELLY


A "lost" novel by James M. Cain, the author of "The Postman Always Rings Twice" and "Double Indemnity."

'The Longest Way Home'
By ANDREW McCARTHY
Reviewed by CHERYL STRAYED


The actor and travel writer Andrew McCarthy takes a deeply personal journey amid some of the world's most far-flung places.

'How Music Works'
By DAVID BYRNE
Reviewed by JOHN ROCKWELL


Though not strictly a memoir, David Byrne's book about music explores his own personal and professional experiences.

Nonfiction Chronicle
By ABIGAIL MEISEL


New books by Guy Gugliotta, Janet Groth, Siri Hustvedt and Bryan Sykes.


BEST SELLERS

Combined Print & E-Book Fiction

Combined Print & E-Book Nonfiction

Hardcover Fiction

Hardcover Nonfiction

Paperback Trade Fiction

Paperback Mass-Market Fiction

Paperback Nonfiction

All the Lists

Back Page

Growing Up Together
By PERRI KLASS


Slightly below the radar, the Betsy-Tacy children's book series has captivated generations of fans.

Inside the List
By GREGORY COWLES


"The Price of Politics" by Bob Woodward lands at No. 2 on the nonfiction list this week, and now all 17 of his books have been hardcover best sellers.

Editors' Choice


Recently reviewed books of particular interest.

Paperback Row
By IHSAN TAYLOR


Paperback books of particular interest.

Book Review Podcast


This week, Junot Díaz talks about "This Is How You Lose Her"; Julie Bosman has notes from the field; Alex Witchel discusses her memoir "All Gone"; and Gregory Cowles has best-seller news. Sam Tanenhaus is the host.




Stephen King's 'Misery' Back From the Dead in Bucks County

Elmore Leonard to Be Honored by National Book Foundation

Audio Project Offers Four Months of 'Moby-Dick'

REVIEWS BY THE TIMES'S CRITICS

'This Is How You Lose Her'

'Life After Death' by Damien Echols

'The Scientists' by Marco Roth

'Joseph Anton' by Salman Rushdie

'Winter of the World' by Ken Follett

Two or Three Cats

ARCHIVE

Crime Columns

Children's Books

The New York Times Book Review: Back Issues

Editor's Note

Thanks for taking the time to read this e-mail. Feel free to send feedback; I enjoy hearing your opinions and will do my best to respond.

John Williams
Books Producer
The New York Times on the Web

Inician las jornadas en Medicina de Rehabilitación

Inicio :: Durango viernes 21 de sep, 2012

Inician las jornadas en Medicina de Rehabilitación

Por: Hilda Castro / El Siglo De Durango / Durango, Dgo.


El Centro de Rehabilitación y Educación Especial (CREE) cumple 36 años de haber sido fundado y dentro del marco del festejo se programaron jornadas de Tópicos Selectos en Medicina de Rehabilitación Integral, mismas que fueron abiertas al público en general.

Mejoras.En el CREE buscan capacitar de manera constante al personal que se encarga de brindar el servicio médico terapéutico.

Norma Leticia Arrieta Briceño, directora de Rehabilitación y Programas Asistenciales del DIF Estatal indicó que en la dependencia se busca no solo el preocuparse por crecer en infraestructura y equipamiento, sino también en la calidad de la gente que atiende cada espacio y que sus conocimientos estén a la vanguardia.

Las jornadas no solo van enfocadas al personal del CREE sino a la población en general que desee aprender, por fortuna, dijo, se rebasó la expectativa de asistencia pues se contemplaba recibir entre 100 y 120 personas; sin embargo, fueron 250 personas las que se inscribieron.

Los temas a tratar son meramente en rehabilitación, todo lo que implica alrededor de un paciente que requiere atención, desde el área psicológica, médica y terapéutica, estos serán abordados durante los días 20, 21 y 22 de septiembre.

Las jornadas tienen valor curricular de 19 horas y en el caso de los médicos de 21, pues tomarán un curso extra de dos horas.

La funcionaria recalcó que en todas las áreas es importante actualizarse, el CREE de Durango tiene la ventaja de que solo cinco de ellos en toda la República Mexicana cuentan con la licenciatura en Terapia Física, lo que ayuda a que de manera permanente se esté con el tema de enseñanza tratando de innovar a través de la implementación de cursos y jornadas.

Se busca compartir y abrir al público este tipo de eventos, pues el tema de rehabilitación es muy amplio y cada día es mayor la necesidad de preparación, agregó.

El CREE tiene una demanda importante en cuanto a la atención de pacientes, pues se otorgan alrededor de 176 mil servicios anuales, lo que quiere decir que dicho Centro es una área necesitada por la gente, dijo la funcionaria, pues de todos los extractos sociales ha llegado alguna vez alguien que requiera de este tipo de servicios.

El estar preparados es de vital importancia, pues la tecnología lleva a mejorar y no quedarse atrás, y Durango tiene que estar a la altura de cualquier estado y la atención de cualquier padecimiento, con la mejor atención posible, concretó.

Medicare Bills Rise as Records Turn Electronic

http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitals-with-electronic-records.html?pagewanted=1&nl=todaysheadlines&emc=edit_th_20120922



Medicare Bills Rise as Records Turn Electronic
By REED ABELSON, JULIE CRESWELL and GRIFFIN J. PALMER
Published: September 21, 2012



When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, the goal was not only to improve efficiency and patient safety, but also to reduce health care costs.


Robert Burleigh was overbilled for an emergency-room visit because the hospital's electronic records included examinations he had not been given.

But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs forMedicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care.

Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a New York Times analysis of Medicare data from the American Hospital Directory. Regulators say physicians have changed the way they bill for office visits similarly, increasing their payments by billions of dollars as well.

The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone, federal regulators said in a recent report, noting that the largest share of those doctors specialized in family practice, internal medicine and emergency care.

For instance, the portion of patients that the emergency department at Faxton St. Luke’s Healthcare in Utica, N.Y., claimed required the highest levels of treatment — and thus higher reimbursements — rose 43 percent in 2009. That was the same year the hospital began using electronic health records.

The share of highest-paying claims at Baptist Hospital in Nashville climbed 82 percent in 2010, the year after it began using a software system for its emergency room records.

In e-mailed statements, representatives for both hospitals said the increases reflected more accurate billing for services. Faxton also said its patients required more care than in past years.

Over all, hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments at higher levels from 2006 to 2010, the latest year for which data are available, compared with a 32 percent rise in hospitals that have not received any government incentives, according to the analysis by The Times.

The higher coding has captured the attention of federal and state regulators and private insurers like Aetna and Cigna. This spring, the Office of Inspector General for the federal Health and Human Services Department warned that the coding of evaluation services had been “vulnerable to fraud and abuse.”

Some experts blame a substantial share of the higher payments on the increasingly widespread use of electronic health record systems. Some of these programs can automatically generate detailed patient histories, or allow doctors to cut and paste the same examination findings for multiple patients — a practice called cloning — with the click of a button or the swipe of a finger on an iPad, making it appear that the physicians conducted more thorough exams than, perhaps, they did.

Critics say the abuses are widespread. “It’s like doping and bicycling,” said Dr. Donald W. Simborg, who was the chairman of federal panels examining the potential for fraud with electronic systems. “Everybody knows it’s going on.”

When Methodist Medical Center of Illinois in Peoria rolled out an electronic records system in 2006, Dr. Alan Gravett, a former emergency room physician, quickly expressed alarm.

He said the new system prompted doctors to click a box that indicated a thorough review of patients’ symptoms had taken place, even though the exams were rarely performed, while another function let doctors pull exam findings “from thin air” and include them in patients’ records.

In a whistle-blower lawsuit filed in 2007, Dr. Gravett contended that these techniques drove up Medicare reimbursement levels substantially. According to the lawsuit, Dr. Gravett was eventually fired for ordering too many tests. He says he was retaliated against for complaining about the new system. The Justice Department is weighing whether to join an amended suit in Federal District Court in Central Illinois.




An independent analysis by The Times showed that Methodist’s Medicare billings for the highest level of emergency care jumped from 50 percent of its emergency room Medicare claims in 2006 to more than 80 percent in 2010, making the 353-bed hospital one of the country’s most frequent users of high-paying evaluation codes.




Methodist declined to comment on Dr. Gravett’s allegations. But in an e-mailed statement, a spokesman said that not all of the hospital’s billing was done electronically, that it followed professional coding guidelines and that its patients required more care than patients at other hospitals.

Many hospitals and doctors say that the new systems allow them to better document the care they provide, justifying the higher payments they are receiving. Many doctors and hospitals were actually underbilling before they began keeping electronic records, said Dr. David J. Brailer, an early federal proponent of digitizing records and an official in the George W. Bush administration. But Dr. Brailer, who invests in health care companies, acknowledged that the use of electronic records “makes it faster and easier to be fraudulent.”

Both the Bush and Obama administrations have encouraged electronic records, arguing that they help doctors track patient care. When used properly, the records can help avoid duplicate tests and remind doctors about a possible diagnosis or treatment they had not considered. As part of the economic stimulus program in 2009, the Obama administration put into effect a Bush-era incentive program that provides tens of billions of dollars for physicians and hospitals that make the switch.

But some critics say an unintended consequence is the ease with which doctors and hospitals can upcode — industry parlance for seeking a higher rate of reimbursement than is justified. They say there is too little federal oversight of electronic records.

A spokesman for the Health and Human Services Department, however, said electronic health records “can improve the quality of care, save lives and save money.” Medicare, he added in an e-mailed statement, “has strong protections in place to prevent fraud and abuse of this technology that we’re improving all the time.”

He also said Medicare had reduced improper payments in the last two years.

In emergency rooms, which use special billing codes to indicate how much care a patient needs, hospitals have increased their claims for the two highest-paying categories to 54 percent of Medicare claims in 2010, from 40 percent in 2006, according to The Times’s analysis of Medicare data. The Center for Public Integrity, a nonprofit investigative journalism group, recently released a similar analysis.

Some contractors handling Medicare claims have already alerted doctors to their concerns about billing practices. One contractor, National Government Services, recently warned doctors that it would refuse to pay them if they submitted “cloned documentation,” while another, TrailBlazer Health Enterprises, found that 45 out of 100 claims from Texas and Oklahoma emergency-department doctors were paid in error. “Patterns of overcoding E.D. services were found with template-generated records,” it said.

The Office of Inspector General is studying the link between electronic records and billing.

One sophisticated patient witnessed the overbilling firsthand. In early 2010, Robert Burleigh, a health care consultant, came to the emergency room of a Virginia hospital with a kidney stone. When he received the bill from the emergency room doctor, his medical record, produced electronically, reflected a complete physical exam that never happened, allowing the visit to be billed at the highest level, Mr. Burleigh said.

The doctor indicated that he had examined Mr. Burleigh’s lower extremities, but Mr. Burleigh said that he was wrapped in a blanket and that the doctor never even saw his legs.

“No one would admit it,” Mr. Burleigh said, “but the most logical explanation was he went to a menu and clicked standard exam,” and the software filled in an examination of all of his systems. After he complained, the doctor’s group reduced his bill.

As software vendors race to sell their systems to physician groups and hospitals, many are straightforward in extolling the benefits of those systems in helping doctors increase their revenue. In an online demonstration, one vendor, Praxis EMR, promises that it “plays the level-of-service game on your behalf and beats them at their own game using their own rules.”

The system helps doctors remember what they did when they successfully billed for similar patients, and ensures that they do not forget to ask important questions or to perform necessary tests, said Dr. Richard Low, chief executive of Infor-Med Corporation, which developed Praxis. “The doctor can use a chart the way the pilot uses a checklist,” he said.

But others place much of the blame on the federal government for not providing more guidance. Dr. Simborg, for one, said he helped draft regulations in 2007 that would have prevented much of the abuse that now appears to be occurring. But because the government was eager to encourage doctors and hospitals to enter the electronic era, he said, those proposals have largely been ignored.

“What’s happening is just the problem we feared,” he said.




A version of this article appeared in print on September 22, 2012, on page A1 of the New York edition with the headline: Medicare Bills Rise as Records Turn Electronic.

Guía para escribir en Internet

La Real Academia Española (RAE) creó el primer manual práctico de uso de Internet en español; las abreviaturas y las faltas de tildes son aceptadas

En la era de la digitalización, la comunicación sufre profundas transformaciones. En los mensajes de textos, los tuits, y losemoticones , es común encontrarse con palabras abreviadas, neologismos y falta de tildes. Ante este escenario, la Real Academia Española (RAE) creó el primer manual práctico de uso de Internet en español , titulado "Escribir en Internet: guía para los nuevos medios y las redes sociales". Y allí, la premisa fundamental parece ser "si se entiende, sirve".

En los chats suele usarse para manifestar risa o ironía, la expresión "ja". El manual ofrece clasificaciones al respecto. "Un simple ja equivaldría a una risa sardónica o irónica que no denota alegría; un jaja , a una risa sincera; y un jajaja a una carcajada". En tanto "Jejeje es una sonrisa cómplice; jojojo , una risa socarrona; y jijiji , una risilla traviesa o contenida".

Guía para escribir en Internet.
Jerarquizar los contenidos. Priorizar los de mayor importancia, situándolos al inicio de la zona de lectura,

Escribir textos breves y claros,

En los casos de correo electrónico, pensar el mejor momento del día para enviarlos.

El cuerpo de un correo electrónico- aconsejan- no debe superar las 50 líneas (tres párrafos) y debe estar compuesto por textos concisos, claros y escuetos.
En los casos de los chats, se recomienda la utilización de emoticones para reflejar sentimientos o estados de ánimo. Por el contrario, ee deben evitar el uso de mayúsculas, y palabras de jerga.

En el lenguaje simplificado- de mensajería instantáneas o SMS- no son necesarios los artículos, las conjunciones, los adverbios y las preposiciones.ga o abreviaturas no conocidas.

A partir del 2014 los términos que hacen referencia a la red social Twitter como "tuitear", o "tuit" serán incorporados a la vigésima terrcera edición del diccionario de RAE.

Los emoticones (íconos que se usan como palabras), son aconsejados por los expertos para las conversaciones por Internet, pero no para cartas formales o exámenes. El manual incluso explica cómo usarlos.
Fuente:http://www.lanacion.com.ar/1510486-los-nuevos-terminos-aceptados-en-la-era-de-la-digitalizacion

CANGREJOS Y LANGOSTAS

http://www.odisea2008.com/2012/09/cangrejos-y-langostas.html

VIERNES, 21 DE SEPTIEMBRE DE 2012

CANGREJOS Y LANGOSTAS

La obra Â Versuch einer Naturgeschichte der Krabben und Krebse. Nebst einer systematischen Beschreibung ihrer verschiedenen Arten, que traducido (muy libremente), del alemán seria: “Historia natural de los cangrejos y langostas, descripción sistemática de los diferentes tipos”, de Johann Friedrich Wilhelm Herbst editada en Berlín en 1790, nos presenta 62 laminas coloreadas a mano, la encuentran en varias fuentes la primera en la Humboldt Universitat zu Berlin ENLACE, y también a través de Zentrales Verzeichnis Digitalisienter Drucke (zvdd) en este otro ENLACE .

Veamos una muestra de las láminas de la obra, para ampliar piquen sobre la imagen y en el servidor escojan tamaño original.

He corregido la exposición y recortado el sobrante de los originales.

Saludos.

Ultima jornada del 1°er Congreso internacional y 10 Curso taller de Patología quirúrgica del pie

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1°er Congreso Internacional y 10 Curso Taller de patología quirúrgica del pie. 20/IX/2012

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3ª Conferencia sobre calidad de revistas de ciencias sociales y humanidades (CRECS 2013)

CRECS 2013




3ª Conferencia sobre calidad de revistas de ciencias sociales y humanidades (CRECS 2013)

Sevilla, 9 de mayo de 2013.
Organizada por el Grupo ThinkEPI y EPI SCP, con la colaboración con la Universidad de Sevilla.
Lugar: Pabellón de México, Salón de Actos.
Avenida de la Palmera, s/n.
41013 Sevilla.
http://www.doctorado.us.es/web/guest/cp-localizacion

Comité Científico:
Ernest Abadal, María-Luisa Álvarez-de-Toledo (Univ. Oviedo, Tomàs Baiget(EPI), Lluís Codina (UPF), Antonia Ferrer (UPV), Nieves González-Fernández-Villavicencio (UPO, Javier Guallar (UB, URL), Alexandre López-Borrull (UOC),Isabel Olea (Univ. León), José-Antonio Moreiro (UC3M), Enrique Orduña-Malea(UPV), Fernanda Peset (UPV), Pilar Ostos-Salcedo (US), Juan-Antonio Pastor-Sánchez (UM), Luis Rodríguez-Yunta (CCHS-CSIC), Carlos-Miguel Tejada-Artigas (UCM), Daniel Torres-Salinas (Univ. Navarra).

Presentación de ponencias y comunicaciones:

La Conferencia CRECS se caracteriza por su dinámica, propia de un entorno en plena ebullición como es el de las revistas científicas. La base de la jornada es la discusión, la participación y el intercambio de ideas. Por ello se concede mucho protagonismo a las mesas redondas.

Debido a la cantidad de presentaciones que normalmente optan a ser expuestas, el Comité Científico se ve obligado a solicitar:
comunicaciones estándar de sólo 15 min + 5 minutos de preguntas; en casos justificados el Comité Científico podrá autorizar presentaciones más largas;
comunicaciones tipo póster, proyectado y presentado en la sala de actos como las comunicaciones, con 10 min de explicación, sólo para dar a conocer nuevos proyectos, o situación de otros proyectos anteriores;
pocos preámbulos, gran concisión y brevedad. Ir al grano;
evitar describir situaciones rutinarias de las revistas que no aporten debate y discusión;
presentar sólo novedades y análisis recientes.

Los interesados en participar, por favor envíen sus propuestas o sugerencias a:
thinkepi@gmail.com

Ediciones anteriores:

CRECS 2, Valencia, UPV, Informática, 10 de mayo de 2011.
http://www.thinkepi.net/crecs2012

CRECS 1, Barcelona, URL, Comunicació-Blanquerna, 3 de mayo de 2010.
http://www.thinkepi.net/cronica-de-la-jornada-crecs-sobre-calidad-de-las-revistas-en-ciencias-sociales

1°er Congreso Internacional y 10 Curso Taller de Patología Quirúrgica del pie

1°er Congreso Internacional y 10 Curso Taller de Patología Quirúrgica del pie

Parte 1 19/IX/2012

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Live Show [Procaster] Wed Sep 19 2012 01:18:12 PM

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1°er Congreso Internacional y 10 Curso Taller de Patología Quirúrgica del pie

1°er Congreso Internacional y 10 Curso Taller de Patología Quirúrgica del pie

Parte 2 19/IX/ 2012

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Live Show [Procaster] Wed Sep 19 2012 03:10:55 PM

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